School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Marquina, Talic, Zomer, Vargas-Torres, Petrova, Wolfe, Abushanab, Ofori-Asenso, Liew, and Ademi); Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia (Ademi).
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Marquina, Talic, Zomer, Vargas-Torres, Petrova, Wolfe, Abushanab, Ofori-Asenso, Liew, and Ademi).
J Clin Lipidol. 2022 Jul-Aug;16(4):498-507. doi: 10.1016/j.jacl.2022.05.002. Epub 2022 May 11.
The attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in real-world settings among patients receiving combination lipid-lowering therapy (LLT, statins plus non-statins) is not well characterised.
To evaluate LDL-C levels and LDL-C goal attainment in patients treated with combination LLT in real-world primary care settings.
A retrospective cohort study of patients treated with combination LLT. Data were drawn from general practitioner electronic medical records across Australia from 2013 to 2019. The on-treatment goal for LDL-C was < 2 mmol/L (77 mg/dL), as per Australian guidelines.
The cohort analysed included 9,173 individuals treated with combination LLT. The mean age was 65.8 years (standard deviation [SD] 11.5), 60.1% were males, and 56.7% had at least one cardiovascular risk factor. The median on-treatment LDL-C was 2.1 mmol/L (IQR 1.6-2.8), and overall 45.4% of the cohort met LDL-C goals, with individuals on fixed-dose combination of statins plus ezetimibe having the highest rates of achievement (49.8%). In multivariable logistic regression analyses, factors associated with LDL-C goal achievement were male sex (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.6, p < 0.001), aged >80 years (OR 4.2, 95% CI 1.5 - 6.6, p = 0.006), and a history of T2DM (OR 1.7; 95% CI 1.5-1.9, p < 0.001) or coronary heart disease (OR 1.4, 95% CI 1.2 - 1.6, p < 0.001).
More than half of Australians on combination LLT did not achieve LDL-C goals. Urgent measures are needed to address this gap in clinical practice to minimise negative health outcomes.
在接受联合降脂治疗（他汀类药物加非他汀类药物）的患者中，在真实环境中实现低密度脂蛋白胆固醇（LDL-C）治疗目标的情况并不清楚。
评估真实环境中接受联合降脂治疗的患者的 LDL-C 水平和 LDL-C 达标情况。
这是一项回顾性队列研究，纳入了在澳大利亚接受联合降脂治疗的患者。数据来自 2013 年至 2019 年期间全科医生的电子病历。根据澳大利亚指南，LDL-C 的治疗目标为<2mmol/L（77mg/dL）。
分析的队列纳入了 9173 名接受联合降脂治疗的患者。患者的平均年龄为 65.8 岁（标准差[SD]为 11.5），60.1%为男性，56.7%有至少一个心血管风险因素。治疗中的 LDL-C 中位数为 2.1mmol/L（IQR 1.6-2.8），总体而言，45.4%的患者达到了 LDL-C 目标，使用他汀类药物加依折麦布固定剂量联合治疗的患者达标率最高（49.8%）。在多变量逻辑回归分析中，与 LDL-C 目标达标相关的因素包括男性（比值比[OR]为 1.4，95%置信区间[CI]为 1.3-1.6，p<0.001）、年龄>80 岁（OR 为 4.2，95%CI 为 1.5-6.6，p=0.006）以及患有 2 型糖尿病（OR 为 1.7；95%CI 为 1.5-1.9，p<0.001）或冠心病（OR 为 1.4，95%CI 为 1.2-1.6，p<0.001）。
超过一半的澳大利亚人接受联合降脂治疗，但未能达到 LDL-C 目标。需要采取紧急措施来解决这一临床实践中的差距，以尽量减少不良健康后果。
